颅内动静脉畸形的术中超声应用研究

Application of intraoperative ultrasound in the surgical treatment of arteriovenous malformations

目的探讨超声在颅内动静脉畸形手术中的应用价值。方法对22例颅内动静脉畸形患者术中采用超声确定畸形血管团的数目、位置、深度、大小、范围及其与周边组织结构的关系,探查其供血动脉及引流静脉的数目及走行;手术前后采用频谱多普勒检测供血动脉及引流静脉的血流动力学参数,并观察频谱形态。结果22例患者术中超声准确定位畸形血管团位置和边界,16例超声可探及明显供血动脉及引流静脉,6例术中未探及明显供血动脉及引流静脉,术后病理证实为动静脉畸形部分呈海绵状血管瘤结构。2例患者术后行彩色多普勒超声扫查显示仍有畸形血管团残留,指导切除残留畸形血管。颅内动静脉畸形供血动脉多普勒频谱呈高速低阻型,RI较正常血管明显降低,为0.23～0.42,平均0.34±0.06,术后显著升高为0.47～0.59,平均0.51±0.04,手术前后相比差异有统计学意义(P<0.01)。结论术中超声可实时定位颅内动静脉畸形位置,根据脉冲多普勒频谱特征确认供血动脉和引流静脉,减少脑组织损伤,缩短手术时间,判断手术切除完整性。

Objective In order to distinguish feeding arteries and draining veins from normal vessels and to evaluate the resection completeness,we adopted intraoperative color Doppler ultrasound in 22 patients. Methods These 22 patients with AVM underwent resection. Color Doppler was applied to the vessels in proximity to the AVM, and RI was used to identify the malformation vascular balls and the abnormal vessels. After surgical resection of the AVM, the first thing was to confirm whether the resection of the AVM was complete or not and to observe the changes of the parameters. Results The AVM vascular balls could be identified directly by introperative ultrasound in all cases. The feeding arteries and draining veins could be correctly located in 16 of them, while the others were proved to be AVM with cavernous hemangioma and 2 cases had residual vascular balls. The waveform of the feeding artery showed higher systolic peak velocities and noticeable low-resistance, while the draining vein was arterialized. The AVM vascular balls were confirmed completely resected via postoperative angiography in all patients. Conclusions Intraoperative color Doppler ultrasound allowed more accurate localization of the AVM vascular balls and the completeness of resection.The parameters including RI of the vessels helped to identify the abnormal vessels.